MITRAL REGURGITATION CAN BE CAUSED BY ABNORMAL TRACTION ON THE LEAFLET BY THE SECONDARY CHORDAE DUE TO MALPOSITION OF THE PAPILLARY MUSCLES.

1. Seagull
MITRAL VALVE

2. PATIENTS WITH MODERATE OR IMPORTANT
MITRAL REGURGITATION WITHOUT ANY
APPARENT MITRAL LESION TO TWO-
DIMENSIONAL TRANSTHORACIC OR
TRANSESOPHAGEAL ECHO.
MAINLY ASSOCIATED WITH LEFT VENTRICULAR
HYPERTROPHY.

3. Messas, E. et al; Circ Cardiovasc Imaging. 2010;3:679-686
NON-UNIFORM TENSION IN A MITRAL LEAFLET DUE TO PM DISPLACEMENT LEADING TO INCREASE
TRACTION ON THE BASAL CHORDAE TENDINEAE (SECONDARY) THAN ON THE MARGINAL (PRIMARY).

4. Messas E, et al. Efficacy of chordal cutting to relieve chronic persistent
ischemic mitral regurgitation. Circulation 2003;108 Suppl 1:II111-115).
SURGICAL TREATMENT COULD BE CUTTING THE SECONDARY CHORDAE
THAT IS STRETCHING THE MITRAL LEAFLET

6. HOW TO DIAGNOSE?
SECONDARY CHORDAE ARE NORMAL AND
THEREFORE THE DEMONSTRATION OF THESE
STRUCTURES ON TWO-DIMENSIONAL ECHO
DOES NOT INDICATE THAT THEY ARE CAUSING
REGURGITATION.

7. IN THE ABSENCE OF ABNORMAL TRACTION, THE ATRIAL FACE OF THE
MITRAL LEAFLET HAS A SURFACE RELATIVELY SMOOTH.

8. WHEN THERE IS AN ABNORMAL SECONDARY CHORDAE
TRACTION ON THE VENTRICULAR FACE OF THE MITRAL LEAFLET
IT USUALLY PRODUCES A DENT ON THE ATRIAL FACE.

9. SEAGULL MITRAL VALVE
WOMAN, 48 y.o., ARTERIAL HYPERTENSION,
DIABETES AND MITRAL REGURGITATION.

11. DENT ON THE LEAFLET

12. SEAGULL MITRAL VALVE
WOMAN, 55 y.o., ARTERIAL HYPERTENSION
AND MITRAL REGURGITATION.

16. SEAGULL MITRAL VALVE
MAN, 59 y.o., ARTERIAL HYPERTENSION
AND MITRAL REGURGITATION.

17. VENTRICULAR SIDE VIEW OF CHORDAE FROM TWO PM WITH TRACTION
ON THE MITRAL LEAFLET.

18. LEFT ATRIAL SIDE VIEW

19. "SEAGULL" MITRAL VALVE REGURGITATION CAN BE EASILY DIAGNOSED
BY THREE-DIMENSIONAL ECHO.
THIS TYPE OF MITRAL REGURGITATION MAY BE RELATIVELY FREQUENT.
FURTHER RESEARCHS ARE NEEDED.
As of my knowledge, these echo findings have not yet been described.

20. END